What is Azoospermia ?

Azoopsermia is defining as complete absence of sperm in the ejaculate sample. If no sperm are seen in the wet preparation of the semen sample, the world health organization recommends centrifugation of the semen sample at 3000 g for 15 minutes at room temperature followed by a high- powered microscopic examination of the pellets formed. If still no sperms are seen, a second semen analysis with similar centrifugation is repeated after 3 to 5 days abstinence. If no sperms are seen in two samples the patient is declared as Azoopsermia. A varicocele is an enlarged vein in the scrotum or testicle. This enlarged vein causes blood to pool in the area, which increases the heat of the testicles and may also cause swelling, testicle shrinkage, and discomfort. Varicoceles are common cause of male infertility.

Most of the time, varicocele lead to lower sperm counts. However, between 4 and 13 percent of men with a varicocele will have severe low sperm count or even azoospermia.

These are two types of azoospermia

  1. Obstructive Azoopsermia: - Obstruction is responsible for approximately 40% of cases of Azoopsermia. Obstructive azoospermia may result from blockage in any of the tubes leading from the testicle to the opening in the tip of the penis. These tubes are:-
  • Epididymis
  • Vas Deferens
  • Ejaculatory duct

Vasectomy is the most common cause of obstruction in the vas deferens. Severe genital or urinary infections, injury during scrotal or inguinal surgery and birth defects are other common causes of obstructive azoospermia.

  1. Non- obstructive Azoopsermia: - Non-obstructive azoospermia (NOA) is defined as no sperm in the ejaculate due to failure of spermatogenesis and is the most severe form of male infertility. Non-obstructive azoospermia is diagnosed in approximately 10% of infertile men. It represents a failure of spermatogenesis within the testis and, from a management standpoint, is due to either a lack of appropriate stimulation by gonadotropins or an intrinsic testicular impairment.

Treatment of Azoopsermia

In some cases, azoospermia can be treated with medication. For example, retrograde ejaculation can sometimes be treated with medications, which can then enable natural conception. Hormones or hormonal drugs used to treat male fertility may include Clomid, Letrozole, FSH injections, or HCG injections.

Testicular Sperm Extraction with IVF and ICSI

Testicular sperm extraction, or TESE, may be used to extract sperm cells directly from the testes. Patient will receive sedation or general anesthesia before the procedure. The doctor will make a small incision in the scrotum and extract tissue from your testes. That tissue will be examined for sperm cells.

TESE can be used when obstructive azoospermia is blocking sperm cells from getting into the ejaculate. TESE may also be used in cases of non-obstructive azoospermia to look for some usable, mature sperm cells that may be being produced, but not enough to get into the semen ?

Sperm cells extracted via TESE can only be used with IVF and ICSI. ICSI—which stands for Intracytoplasmic sperm injection—is when a single sperm cell is directly injected into an egg. If successful fertilization takes place then the resulting embryo is transferred to the woman’s uterus.

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